La rata Wistar como modelo animal experimental, para el adiestramiento laparoscópico de residentes con entrenadores pélvicos

We describe a new animal model for training resident physicians in gynecological endoscopy. The surgery and training exercises are performed in live, anesthetized, Wistar rats in a pelvitrainer for gynecological endoscopy. The pelvitrainer is used to practice dissection, cutting, electrocoagulation, mobilization of structures in the abdominal cavity, subtotal hysterectomy with double anexectomy, extraction of the surgical specimen in a bag, and knotting to close the surgical wound. Twelve hours of training are sufficient for third-year resident surgeons to master the movements required to perform these techniques in humans.     

Pelvic floor disease

The pelvic floor is one of the most complex structures of the human body. Historically, the approach to pelvic floor disease has been "vertical": the anterior compartment was the domain of urologists, the middle compartment was the domain of gynecologists with frequent incursions into the female anterior compartment, and the posterior compartment was reserved for surgeons. In the last few years, a change has occurred in the philosophy underpinning the management of these diseases with the development of an integrative "cross sectional" approach which affects the physiology, physiopathology, and the definition of these diseases as an integrated structure, and which includes urinary and fecal incontinence, pelvic organ prolapse, alterations in the perception of urinary tract emptying, chronic constipation, sexual dysfunctions, and several chronic pain syndromes in the perineal area. We believe that the efforts of the various professionals involved in the treatment of these disorders should be pooled and that pelvic floor units should be created. These units should be characterized by a multidisciplinary approach, since the skills and knowledge necessary for the management of these patients requires teams composed of professionals with a broad range of competencies.     

Cistitis intersticial como causa de dolor pélvico crónico en ginecología

Interstitial cystitis is a complex chronic inflammatory syndrome of the bladder that is more frequent than is commonly believed. The pathogenesis of this entity involves an alteration of the permeability of the urothelium, leading to a failure of its protective function of providing a barrier. The most common symptoms are frequency (an increase in the number of micturitions), voiding urgency, abdominal, urethral or genital pain, dyspareunia and a variety of other symptoms. Diagnosis of interstitial cystitis is generally difficult and is often made by exclusion or on the basis of clinical improvement produced by therapeutic maneuvers such as overdistension. Cystoscopy plays an important role in diagnosis, a classical finding being Hunner ulcer; among other tests, bladder biopsy and the potassium sensitivity test are also useful.     

Effects of pelvic floor muscle training during pregnancy

OBJECTIVE: The objective of the present study was to evaluate the effect of pelvic floor muscle training in 46 nulliparous pregnant women. METHODS: The women were divided into 2 groups: an exercise group and a control group. Functional evaluation of the pelvic floor muscle was performed by digital vaginal palpation using the strength scale described by Ortiz and by a perineometer (with and without biofeedback). RESULTS: The functional evaluation of the pelvic floor muscles showed a significant increase in pelvic floor muscle strength during pregnancy in both groups (P < .001). However, the magnitude of the change was greater in the exercise group than in the control group (47.4% vs. 17.3%, P < .001). The study also showed a significant positive correlation (Spearman's test, r = 0.643; P < .001) between perineometry and digital assessment in the strength of pelvic floor muscles. CONCLUSIONS: Pelvic floor muscle training resulted in a significant increase in pelvic floor muscle pressure and strength during pregnancy. A significant positive correlation between functional evaluation of the pelvic floor muscle and perineometry was observed during pregnancy.     

Evisceración intestinal a través de vagina

Objectives

We describe an uncommon postoperative complication, vaginal evisceration of the intestine, and review the predisposing factors, diagnosis and definitive corrective surgery, the surgical approaches and possible surgical techniques, based on the available scientific literature.

Actinomicosis pélvica en una paciente sin relaciones sexuales previas

The presence of an abdominal mass may be symptomatic or it could be found in a routine physical examination. Before this is diagnosed some further tests should be done for the differential diagnosis of the mass, whether it is of gynaecological origin and if the pathology is benign or malignant. The mass may be accompanied by acute or chronic pain. Pelvic actinomycosis is a rare cause of such signs and it is usually associated with the use of an intrauterine device. Here we present a case of chronic abdominal pain with cyst of ovary in a 20-year-old patient without previous sexual activity.     

Pelvic reconstruction after abdominoperineal resection of the rectum

Despite the advances in the treatment of cancer of the rectum and the expansion of the multimodal therapeutic technique, abdominoperineal resection (APR) still needs to be performed as radical treatment in 20-30% of cases.APR of the rectum involves a significant morbidity, including intestinal obstruction and wound complications, with radiotherapy-induced enteritis being able to develop in 15% of cases subjected to post-operative radiotherapy. Furthermore, with the aim of improving local oncology results, an extended APR is recommended; a technique that requires a perineal reconstruction technique that allows a tension free closure in a previously radiated tissue and may prevent perineal hernias developing.The objective of this article is to review pelvic and perineal repair methods after APR due to cancer, with special attention to the new prosthetic repair techniques.     

Absceso pélvico y tubo-ovárico en mujer portadora de DIU hace 16 años

We present a case of acute abdomen caused by rupture of a tubo-ovarian abscess in a 38-year-old woman who had been using an intrauterine device for 16 years. The diagnosis was made during surgery, since the intervention was performed for suspected acute appendicitis. The intervention revealed a right tubo-ovarian abscess with pelvic abscess. Culture of pelvic pus was positive for Streptococcus constellatus. The patient was treated by surgery and combined antibiotic therapy. Diagnosis was confirmed by histopathological examination.